1. Training charter - Interventional Neuroradiology

2. Olof Flodmark Professor Chairman UEMS Division of Neuroradiology, Section of Radiology President Elect World Federation of Neuroradiological Societies

3. EU law EU rules are automatically part of national law of all EU member states Aim is to arrive at one common judicial system EU directives (recommendations) Guidelines that should, in one way or the other, be incorporated in national law Aim is to make national law systems more similar EU communications Soft power to influence EU member states The European Commission takes a position

4. EU law Management of national health care systems are decided by each of the EU member states for themselves But the European Court of Justice ruled that: “EU treaties apply also to health care” Hence: EU directives (!) supersede national law even if this has implications for national health care

5. EU law EU directives (recommendations) These laws need to be updated every few years Directive 2005/36/CE Includes rules for Specialization of Doctors – up for renewal 2012

6. EU law Directive 2005/36/CE It is the plan of UEMS to present for that revision the concept of: Particular competence

7. Why “particular competence”? The available specialties do no longer reflect the development within medicine Yet ………. There is a political drive to limit the number specialties.

8. Why “particular competence”? For example: Oncology is a well recognized body of knowledge Yet there is no Section of Oncology – have tried for > 20 years Another example: Intensive care medicine

9. Why “particular competence”? Particular competence: A competence that is shared by many specialties Could be a competence over and above a number of different specialites

10. Why “particular competence”? Particular competence in oncology: Neurooncology Paediatric oncology Gynecological oncology Chest oncology Etc………..

11. Why “particular competence”? A doctor with Particular competence: Will have to have a basic specialty This can be of different kinds Any specialist can obtain “particular competence” The training will have to be tailored!

12. Why “particular competence”? Particular competence: Is not meant to be a new specialty Can only be obtained by specialists Will maybe satisfy politicians Will satisfy the needs of the profession Does not exist today!

13. Why “particular competence”? The plan of UEMS is: To use oncology and intensive care medicine as pilots To lobby for this addition in 2012 Any other can join the line up and if successful – can join the pilots

14. In UEMS: How are new documents processed?

15. The process The givens: UEMS is a political organization UEMS is a hierarchic organization All documents that are meant to have a legal status need to be approved by the UEMS Council

16. The process How to work the bureaurocracy? To make sure that there is no opposition along the way! Involve all interested parties in the process from the beginning Develop the document in cooperation using compromises, mutual agreements and acceptance!

17. Training charter - Interventional Neuroradiology

18. Training Charter in INR What is the reality today? INR is practiced by: Neuroradiologists Radiologists Neurosurgeons Neurologists Cardiologists? Vascular surgeons?

19. Training Charter in INR Roadmap: Define the body of knowledge of INR Endovascular INR Surgical treatment Medical treatment Of vascular diseases of the CNS Non vascular INR - separate

20. Training Charter in INR What is Competence? Formal competence Defined by time spent or procedures Real competence Defined by content of training Training institution Examination

21. Training Charter in INR Roadmap: Produce a draft of a training charter Available from the work in ESNR Published in Acta Neurochirurgica The Guidelines of WFITN

24. Training Charter in INR Roadmap: To invite representatives from all Sections and Divisions in UEMS Form a task force charged with the task to produce a document that is accepted by all interested and involved parties.

25. Training Charter in INR Roadmap: The document should build on the concept of “particular competence” as it will have the best chance of being accepted by all interested parties this way. “Exclusion by inclusion”

26. Training Charter in INR The process – past meetings: Brussels June 14th 2010 Visby, Sweden, August 28th 2010 Future meetings: Vienna December 4th 2010 Geneva January 10th 2011

27. Training Charter in INR The process - participants: Bernd Richling – Sect. of neurosurgery Wolfgang Grisold – Sect of neurology Laurent Pierot – Div. of neuroradiology Chairman: Olof Flodmark – Div. of Neuroradiology

28. Training Charter in INR The process - participants: Bernd Richling – Sect. of neurosurgery Wolfgang Grisold – Sect. of neurology Laurent Pierot – Div. of neuroradiology Chairman: Olof Flodmark – Div. of Neuroradiology Additional participants in Vienna: Prof Mudra – Sect. of Cardiology Peter Pattynama – Sect. of Radiology

29. Training Charter in INR The process - documents: “Particular competence” in Endovascular Interventional neuroradiolgy – INR Standards of practice in INR

30. The draft proposal - Short version -

31. Particular competence - INR Taking the published WFITN paper (Interventional Neuroradiology 15:11-15, 2009) as a basis a curriculum was created: UEMS recommendations for acquiring “particular competence” in Endovascular Interventional Neuroradiology - INR.

32. Particular competence - INR Construction of the training program is a procedure, supervised by the UEMS and coordinated by the UEMS Division of Neuroradiology, and is a joint responsibility of neuroradiology, neurosurgery and neurology.

33. Particular competence - INR General aspects The applicant must be a specialist physician with a recognized specialty listed in the directive 2005/36/EV of the European Parliament and of the Council on the recognition of professional qualifications.

34. Particular competence - INR General aspects 1 The education and training needed to become a specialist physician with particular competence in Interventional neuroradiology is, depending on previous training, between 3½ yrs and 4½ years of full time study in a INR training program

35. Particular competence - INR General aspects 2 Training in the core of INR can not be less than 30 months. Training in clinical neuroscience can not be less than 12 months. Training in diagnostic neuroradiology can not be less than 12 months.

36. Particular competence - INR General aspects 3 After validation of any background the applicant has acquired in neuro imaging or clinical neuroscience training, the Director of the Program will, together with the applicant, determine which components of this training program must be completed for the trainee to have acquired particular competence in INR.

37. Particular competence - INR Network of institutions A training program is based on a formalized network of accredited institutions/departments

38. Particular competence - INR Training program - Objectives Interventional neuroradiology should ideally be practiced in INR teams where exchange of experience, knowledge and research is possible. Having finished the training program, a specialist physician with particular competence in INR, will be able to perform endovascular procedures as described in Art 3 in a team with other interventional neuroradiologists. Thus solitary practice of INR is not recommended.

39. Particular competence - INR Knowledge-based Objectives A list of objectives has been established (see attachment) Each trainee must participate in a minimum of 150 endovascular INR procedures. of which at least in 50 should be as the principal operator. Log-book during INR training Evaluation of trainee

40. Particular competence - INR Requirements for training institutions/departments To qualify as a training program the following conditions must be fulfilled. Senior Academic appointments of director and co- directors (neurology, neurosurgery and neuroradiology) are required The network must/should be involved in active research in INR

41. Particular competence - INR Requirements for training institutions/departments The INR core must fulfill the following conditions. The faculty of the training program must include at least two members practicing INR full time. The proportion of trainers in INR to trainees must not exceed the ratio of 1:2. INR Case load (150 – 200 cases/year) of endovascular interventions INR Case mix (stroke, aneurysms, AVMs and DVMs and spinal vascular malformations)

42. Particular competence - INR Certification of particular competence The program director is responsible for certification of the training and acquired particular competence dependent on a properly executed accreditation and visitation process. UEMS strongly encourages a final board examination.

43. Particular competence - INR Maintenance of competence. Particular competence in INR is maintained by practising INR 80 – 100% time and by participating in appropriate CME/CPD activities.

48. 2345671 Neuroradiology Neurosuregery Neurology Radiology Training Charter in INR Intensive Care Medicine

49. 2345671 Neuroradiology NeurosuregeryNeurology Radiology Training Charter in INR Intensive Care Medicine

50. 2345671 Neuroradiology Neurosuregery Neurology Radiology Training Charter in INR Intensive Care Medicine

51. 2345671 Neuroradiology Neurosuregery Neurology Radiology Training Charter in INR Intensive Care Medicine